WHO and UNICEF call for renewed commitment to breastfeeding

Manila, 20 June 2007 – Exclusive breastfeeding rates in East Asia and the Pacific are just 61% at four months of babies' lives and even lower, at 35%, at six months. And yet science has established that exclusive breastfeeding for the first six months of a child's life is the single best strategy for the infant’s survival, growth and development.

This is an alarming threat to child survival, according to WHO and UNICEF, which have urged governments in East Asia and the Pacific to invest more in protecting, promoting and supporting breastfeeding. The UN organizations say more needs to be done to inform parents of the merits of breastfeeding and the dangers of breast milk substitutes, to crack down on violations of the International Code of Marketing of Breast-milk Substitutes, and to better fund public health systems for delivering breastfeeding support services to mothers and families.

The joint WHO/UNICEF call comes at the opening of a three-day consultation of 70 regional and global public health experts in Manila on how to better protect, promote and support breastfeeding. The meeting will focus on how to discourage a bottle-feeding culture by tackling the influence of breast milk substitutes and effectively promoting the evidence for why breast is still best.

In the Philippines, the rate of exclusive breastfeeding at four to five months fell from 20% in 1998 to 16% in 2003. It is estimated that 16,000 deaths of children under five in the Philippines are caused by inappropriate feeding practices, including the use of infant formula. In response, the Department of Health has proposed new Implementing Rules and Regulations of the National Milk Code to ensure full enforcement of the International Code of Marketing of Breast-milk Substitutes and to prevent any violations by infant formula makers.

“Poor nutrition is the greatest contributing factor to under-five mortality rates,” says Dr Shigeru Omi, the Regional Director of the WHO Regional Office for the Western Pacific. ”Breastfeeding provides a natural safeguard for a child in the first months of life and plays a critical role in growth and development.” The Joint WHO/UNICEF Regional Child Survival Strategy, which has been endorsed by all Member States in the Western Pacific Region, recommends exclusive breastfeeding for the first six months as one of the key components of an essential child-survival package.

Breast milk contains hundreds of health-enhancing antibodies and enzymes that stimulate the immune system and improve children's response to vaccinations. It also helps to prevent diarrhoea, pneumonia, and sudden infant death syndrome (SIDS), and contributes to child-spacing.

In addition to the short-term benefits to a child’s and mother’s health, evidence increasingly indicates breastfeeding's role in preventing chronic disease in adulthood. A recent WHO review of global studies shows that breastfed children have a lower mean blood pressure, lower total cholesterol, as adults, and higher performance in intelligence tests. Also, the prevalence of overweight/obesity and type 2 diabetes is lower among adults who were breastfed as children. Breastfeeding reduces the incidence of asthma, allergies, childhood cancers, diabetes, Crohn's disease, colitis, obesity, cardiovascular disease and ear infections, while promoting cognitive development and school performance.

In many countries in the region, the combination of weak public health systems, slick and expensive marketing of milk formula and poor enforcement of marketing regulations have contributed to the decline of breastfeeding. Often, poorly funded public health systems are failing to fully equip health workers with the skills and knowledge to assist new mothers in how to breastfeed. The problem is compounded when poorly paid health workers are offered incentives and gifts by formula companies to promote their products.

In addition to the public health benefits of breastfeeding, the economic savings for both families and health systems are potentially enormous. This is especially critical for poorer families, who are increasingly spending a large part of their income on infant formula, convinced that it is a way to improve their child’s intelligence and thus chances for a better life. WHO Philippines estimates that Filipinos are spending US$465 million (21.5 billion pesos) a year to formula-feed their infants.

In sharp contrast to the regional trend, Cambodia has experienced a surge in women who are exclusively breastfeeding during their babies’ first six months. The rates have increased from 11% in 2000 to 60% in 2005 – largely due to parents learning that giving water to their babies is not necessary. This appears to have contributed to a dramatic decrease in child mortality rates: falling from 95 infant deaths and 124 under-five deaths for every 1,000 live births in 2000, to 65 and 83, respectively in 2005. Cambodia’s success is in part the result of an aggressive campaign to educate women on the importance of breastfeeding that involved public awareness education through the media and creating “breastfeeding-friendly” sites in villages.

“Within the region, child survival is affected by poor water quality, hygiene and sanitation. Combine unsanitary water with the replacement of breastfeeding by infant formula and the threat becomes even deadlier,” says Anupama Rao Singh, UNICEF’s Regional Director for East Asia and Pacific. “We need to ensure that we remain committed to protecting, promoting and supporting breastfeeding by helping mothers and their families understand the benefits. This means governments must remain committed to enforcing the International Code of Marketing of Breast-milk Substitutes and also invest much more in the public health system.”